Milk-alkali Syndrome
Milk-alkali Syndrome
Overview
Milk-alkali syndrome, also known as Burnett's syndrome, is characterized by the triad of hypercalcemia, metabolic alkalosis, and renal insufficiency, resulting from excessive consumption of calcium and absorbable alkali.
Historical Context
- Originally described in the 1920s during peptic ulcer treatment
- Modern cases often related to calcium supplement overconsumption
- Increasing prevalence due to widespread calcium supplementation
- Now termed Calcium-alkali syndrome in contemporary medicine
Pathophysiology
- Excessive calcium absorption
- Alkalosis-induced decrease in calcium excretion
- Volume depletion causing increased proximal reabsorption
- Reduced glomerular filtration rate
- Positive feedback loop perpetuating hypercalcemia
Clinical Manifestations
Acute Symptoms
- Nausea and vomiting
- Headache
- Confusion
- Weakness
- Lethargy
- Constipation
Chronic Manifestations
- Band keratopathy
- Metastatic calcifications
- Nephrolithiasis
- Chronic kidney disease
- Bone pain
Risk Factors
- Excessive calcium supplementation
- Pregnancy
- Chronic kidney disease
- Elderly patients
- Medications affecting calcium metabolism
- Volume depletion
Diagnostic Approach
Laboratory Studies
- Serum calcium (elevated)
- Blood pH and bicarbonate (elevated)
- Serum creatinine (elevated)
- PTH levels (suppressed)
- Vitamin D levels
- Phosphorus levels
Diagnostic Criteria
- History of calcium/alkali ingestion
- Hypercalcemia (>10.5 mg/dL)
- Metabolic alkalosis (pH >7.45)
- Acute or chronic kidney injury
- Absence of other causes of hypercalcemia
Differential Diagnosis
- Primary hyperparathyroidism
- Malignancy-associated hypercalcemia
- Vitamin D toxicity
- Sarcoidosis
- Other granulomatous diseases
Treatment Strategies
Acute Management
- Discontinuation of calcium/alkali sources
- Volume repletion with normal saline
- Loop diuretics if needed
- Monitoring of electrolytes
- Hemodialysis in severe cases
Long-term Management
- Dietary calcium restriction
- Regular monitoring of calcium levels
- Renal function monitoring
- Patient education
- Alternative approaches for original condition
Prevention Strategies
- Appropriate calcium supplementation
- Regular monitoring in high-risk patients
- Education about calcium-containing products
- Proper hydration maintenance
Complications and Prognosis
Acute Complications
- Acute kidney injury
- Mental status changes
- Cardiac arrhythmias
- Seizures
Chronic Complications
- Chronic kidney disease
- Metastatic calcifications
- Cardiovascular calcifications
- Bone demineralization
Monitoring Parameters
- Serial calcium measurements
- Renal function tests
- Acid-base status
- Electrolyte panel
- Cardiovascular assessment
